ObjectiveTo investigate the triglyceride-glucose (TyG) index and the level of serum homocysteine (Hcy) in association with the incidence of stroke in type 2 diabetes mellitus (T2DM) patients. MethodsBased on the chronic disease risk factor surveillance cohort in Pudong New Area, Shanghai, excluding those with stroke in baseline survey, T2DM patients who joined the cohort from January 2016 to October 2020 were selected as the research subjects. During the follow-up period, a total of 318 new-onset ischemic stroke patients were selected as the case group, and a total of 318 individuals matched by gender without stroke were selected as the control group. The Cox proportional hazards regression model was used to adjust for confounding factors and explore the serum TyG index and the Hcy biochemical indicator in association with the risk of stroke. ResultsThe Cox proportional hazards regression results showed that after adjusting for confounding factors, the risk of stroke in T2DM patients with 10 μmol·L⁻¹-¹ and Hcy>15 μmol·L⁻¹ was 1.532 times (95%CI: 1.017‒2.309 times, P=0.041) and 1.738 times (95%CI: 1.119‒2.699 times, P=0.014) higher respectively, compared to T2DM patients with Hcy≤10 μmol·L⁻¹. T2DM patients with TyG>9.074 had 1.396 times higher risk of stroke (95%CI: 1.091‒1.787, P=0.008) compared to those with TyG≤9.074. The study found that urea and α1-antitrypsin (α1-AT) were independent risk factors for the incidence of stroke in T2DM patients. For every unit increase in urea andα1-AT, the risk of stroke in T2DM patients increased by 233.6% (HR=3.336, 95%CI: 1.588‒7.009, P=0.001) and 11.3% (HR=1.113, 95%CI: 1.028‒1.205, P=0.008), respectively. Cumulative risk curves showed that Hcy>10 μmol·L⁻¹ and TyG>9.074 accelerated the time to stroke occurrence in T2DM patients. ConclusionElevated levels of Hcy>10 μmol·L⁻¹ and a higher TyG index are risk factors for stroke in T2DM patients. Effective interventions for Hcy and TyG should be conducted for diabetic patients to reduce the incidence of stroke.

Kidney disease constitutes a significant global public health issue,with its associated healthcare burden escalating annually.Lipid metabolism disorders play a crucial role in the onset and progression of various kidney diseases.Given the diversity of lipid species and the complexity of metabolic pathways,traditional research methods often fall short in fully elucidating the intricate roles of lipids in kidney diseases.In this context,lipido-mics,the systematic analysis of lipid molecules and their metabolic alterations in biological samples,emerges as a powerful tool with unique research value and clinical potential.This review summarizes the latest findings in lipido-mics across various kidney diseases and discusses the challenges encountered in clinical application and future research directions.

To investigate the association between neutrophil to lymphocyte ratio (NLR) andestimated glomerular filtration rate (eGFR) in patients with diabetes using large-scale data.

Objective To explore the role of sevoflurane(SEV)in sepsis-induced acute lung injury(ALI)and observe its impact on the Wnt/β-catenin signaling pathway.Methods Forty C57 mice were randomly divided into 4 groups(n=10 each):Sham,CLP,SEV,and SEV+XAV(β-catenin inhibitor).A sepsis model was established via cecal ligation and puncture.Lung injury was evaluated using HE staining,lung wet/dry weight ratio,and TUNEL staining.Levels of inflammatory factors(TNF-α,IL-1β,IL-6)were detected by ELISA.Oxidative stress indices(SOD,MDA,ROS)were measured by colorimetry and flow cytometry.Hindlimb blood perfusion and oxygenation were assessed with laser speckle flowmetry.Expressions of key Wnt pathway molecules and down-stream target genes(c-Myc,Cyclin D1)were detected by RT-qPCR and Western blot.Co-localization of β-catenin and SP-C(a marker of type Ⅱ alveolar epithelial cells)in lung tissues was determined by immunofluorescence staining.Results Compared with the Sham group,the CLP group exhibited significant increases in sepsis severity,lung pathological damage including alveolar structure destruction,inflammatory infiltration,and apoptosis,elevation in pro-inflammatory cytokine levels,and significant decrease in SOD and increase in MDA and ROS.Additionally,lower limb blood flow and oxygenation levels were significantly reduced,while the expression of β-catenin and its downstream target genes,as well as the co-localization signal and fluorescence intensity of β-catenin with SP-C,were significantly downregulated(all P<0.05).Compared with the CLP group,the SEV group showed significant improvements in all these indicators.However,compared with the SEV group,the SEV+XAV group demon-strated a reversed protective effect,with all indicators approaching the levels observed in the CLP group(all P<0.05).Conclusion Sevoflurane alleviates sepsis-induced ALI by activating Wnt/β-catenin signaling pathway,exerting anti-inflammatory and antioxidant effects,and enhancing the expression and localization of β-catenin in type Ⅱ alveolar epithelial cells.

Objective To explore the clinical efficacy of superselective arterial embolization in children with Parkes-Weber syndrome(PWS),and the prevention and treatment of postoperative complications.Methods Nine patients with PWS diagnosed by clinical and imaging examinations were selected.Under general anesthesia,the catheter was cannulated to all levels of branch arteries and lesion sites using the Seldinger technique.Absorbent gelatin sponge particle(or lipiodol)was selected according to the angiographic situation,and then target vessel embolization was performed.Patients with venous malformations were treated with local sclerotherapy at the same time.The patients were followed up for 1 month,3 months,6 months and 1 year after the operation to observe the clinical efficacy and complication.Results All 9 patients were successfully treated with interventional therapy.Arteriography showed that micro arteriovenous fistula existed at the distal end of multiple branch arteries,and the arteriovenous fistula had been closed after embolization.Review after 1 month of interventional therapy,the color spot of the affected limb became lighter,the temperature decreased,the leg circumference decreased,and the pain was relieved of all 9 cases.Three patients had skin deep color 2-3 days after the operation,so they were given hirudoid local smear,3 times/day,local warm water wet compress,raised limb position,local massage and other methods,and the local skin color gradually recovered after 1 week;On the 15th day after the operation,2 patients suffered from ischemic necrosis at the embolic site,skin color deepened,and tenderness.They were locally disinfected with hirudoid,aurantium peptide,normal saline,and iodophor.The skin broke and scabbed more than 1 month after the operation,the skin ulcer improved and new granulation tissue grew up 1.5 months after the operation;One case had no obvious reduction of the lesion 1 month after the operation,so the second intervention was performed.Conclusion Superselective arterial embolization is effective in the treatment of PWS in children,but the prevention of complications should be paid attention to and complications should be timely treated.

Kidney disease constitutes a significant global public health issue,with its associated healthcare burden escalating annually.Lipid metabolism disorders play a crucial role in the onset and progression of various kidney diseases.Given the diversity of lipid species and the complexity of metabolic pathways,traditional research methods often fall short in fully elucidating the intricate roles of lipids in kidney diseases.In this context,lipido-mics,the systematic analysis of lipid molecules and their metabolic alterations in biological samples,emerges as a powerful tool with unique research value and clinical potential.This review summarizes the latest findings in lipido-mics across various kidney diseases and discusses the challenges encountered in clinical application and future research directions.

Objective To explore the role of sevoflurane(SEV)in sepsis-induced acute lung injury(ALI)and observe its impact on the Wnt/β-catenin signaling pathway.Methods Forty C57 mice were randomly divided into 4 groups(n=10 each):Sham,CLP,SEV,and SEV+XAV(β-catenin inhibitor).A sepsis model was established via cecal ligation and puncture.Lung injury was evaluated using HE staining,lung wet/dry weight ratio,and TUNEL staining.Levels of inflammatory factors(TNF-α,IL-1β,IL-6)were detected by ELISA.Oxidative stress indices(SOD,MDA,ROS)were measured by colorimetry and flow cytometry.Hindlimb blood perfusion and oxygenation were assessed with laser speckle flowmetry.Expressions of key Wnt pathway molecules and down-stream target genes(c-Myc,Cyclin D1)were detected by RT-qPCR and Western blot.Co-localization of β-catenin and SP-C(a marker of type Ⅱ alveolar epithelial cells)in lung tissues was determined by immunofluorescence staining.Results Compared with the Sham group,the CLP group exhibited significant increases in sepsis severity,lung pathological damage including alveolar structure destruction,inflammatory infiltration,and apoptosis,elevation in pro-inflammatory cytokine levels,and significant decrease in SOD and increase in MDA and ROS.Additionally,lower limb blood flow and oxygenation levels were significantly reduced,while the expression of β-catenin and its downstream target genes,as well as the co-localization signal and fluorescence intensity of β-catenin with SP-C,were significantly downregulated(all P<0.05).Compared with the CLP group,the SEV group showed significant improvements in all these indicators.However,compared with the SEV group,the SEV+XAV group demon-strated a reversed protective effect,with all indicators approaching the levels observed in the CLP group(all P<0.05).Conclusion Sevoflurane alleviates sepsis-induced ALI by activating Wnt/β-catenin signaling pathway,exerting anti-inflammatory and antioxidant effects,and enhancing the expression and localization of β-catenin in type Ⅱ alveolar epithelial cells.

Objective To explore the clinical efficacy of superselective arterial embolization in children with Parkes-Weber syndrome(PWS),and the prevention and treatment of postoperative complications.Methods Nine patients with PWS diagnosed by clinical and imaging examinations were selected.Under general anesthesia,the catheter was cannulated to all levels of branch arteries and lesion sites using the Seldinger technique.Absorbent gelatin sponge particle(or lipiodol)was selected according to the angiographic situation,and then target vessel embolization was performed.Patients with venous malformations were treated with local sclerotherapy at the same time.The patients were followed up for 1 month,3 months,6 months and 1 year after the operation to observe the clinical efficacy and complication.Results All 9 patients were successfully treated with interventional therapy.Arteriography showed that micro arteriovenous fistula existed at the distal end of multiple branch arteries,and the arteriovenous fistula had been closed after embolization.Review after 1 month of interventional therapy,the color spot of the affected limb became lighter,the temperature decreased,the leg circumference decreased,and the pain was relieved of all 9 cases.Three patients had skin deep color 2-3 days after the operation,so they were given hirudoid local smear,3 times/day,local warm water wet compress,raised limb position,local massage and other methods,and the local skin color gradually recovered after 1 week;On the 15th day after the operation,2 patients suffered from ischemic necrosis at the embolic site,skin color deepened,and tenderness.They were locally disinfected with hirudoid,aurantium peptide,normal saline,and iodophor.The skin broke and scabbed more than 1 month after the operation,the skin ulcer improved and new granulation tissue grew up 1.5 months after the operation;One case had no obvious reduction of the lesion 1 month after the operation,so the second intervention was performed.Conclusion Superselective arterial embolization is effective in the treatment of PWS in children,but the prevention of complications should be paid attention to and complications should be timely treated.

Membranous nephropathy(MN)is the predominant cause of primary nephrotic syn-drome(NS)among adults.The identification of PLA2R as target antigen has brought about a pro-found transformation in the management of MN,offering a basis for the utilization of B-cell deplet-ing agents such as rituximab(RTX).The question of whether early intervention targeting antibodies can effectively impede the progression of MN,contrib-uting to enhanced disease control and long-term renal outcomes for patients,remains further explo-ration.We analyzed demographic data,laboratory parameters,and renal involvement in 13 patients with PLA2R antibody-related MN who received at least one RTX treatment at our center from Octo-ber 2019 to March 2023.Early-stage medium-to-high-risk MN was defined as baseline or admission anti-PLA2R antibody levels exceeding 50 RU/mL,ex-cluding patients who already presented with ne-phrotic syndrome at baseline.The median duration of MN at the initiation of the first RTX treatment was 4.1 months(IQR 1-7.7),and the median follow-up time after RTX therapy was 27 months(IQR 23-45).All patients had commenced renin-angiotensin system inhibitors before receiving RTX.Following RTX therapy,none of the 13 patients progressed to NS during the follow-up period,and 12 patients achieved complete or partial remission at the 2-year follow-up or the last visit.No deaths,severe infections,or other serious adverse reactions oc-curred during the follow-up period.In conclusion,RTX demonstrates favorable efficacy and safety in early-stage,medium-to-high-risk MN patients.Initi-ating antibody clearance therapy in these patients may be beneficial for long-term disease control and distant renal outcomes.

Objective:To analyze the clinical data of the patients with leucine-rich glioma inactivated 1(LGI-1)antibody-positive autoimmune encephalitis(AE)(LGI-1 AE)complicated with sleep structure abnormality and cognitive impairment,and to discuss the possible pathogenic mechanism.Methods:A 68-year-old male patient was admitted to our hospital due to memory decline for 2 months and seizures for 1 month.After diagnosed with LGI-1 AE,the patient was treated with intravenous immunoglobulin combined with methylprednisolone sodium succinate,resulting in the improved symptoms.Excluding any pharmaceutical influences,the neuropsychological assessments,including sleep evaluations with polysomnography(PSG),were performed during both the acute phase and the recovery phase.Results:During the acute phase assessment,the patient exhibited severe cognitive impairments,scoring 22 on the Mini-Mental State Examination(MMSE)and 19 on the Montreal Cognitive Assessment(MoCA).The PSG results showed that the total sleep time(265 min)was shortened,the sleep fragmentation throughout could be seen,the sleep efficiency was reduced,and N3 and rapid eye movement(REM)sleep stages were complete absent.In the recovery phase,the patient's cognitive functions improved(MMSE score was 30,MoCA score was 26),the total sleep time returned to normal with PSG,the sleep onset latency was 13.5 min,the sleep fragmentation notably improved,the sleep efficiency was increased to 84.3％,the N3 sleep lasted 26 min(5.1％),and the REM sleep lasted 69 min(13.6％).Conclusion:The abnormality in sleep structure and cognitive impairment in the patients with LGI-1 AE are synchronous in onset and outcome,and may be one of the etiologies of cognitive dysfunction in these patients.The pathological origin of the sleep disorder may lie in the hypothalamus.Hypothalamic secretions and the Lhx6 pathway might become new targets for correcting the sleep structure while treating the cognitive impairment.